Provider Demographics
NPI:1003235888
Name:HEALTHFUL WEIGHT MANAGEMNET CLINIC LLC
Entity Type:Organization
Organization Name:HEALTHFUL WEIGHT MANAGEMNET CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-383-9521
Mailing Address - Street 1:3235 S CARRIER PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-6052
Mailing Address - Country:US
Mailing Address - Phone:409-383-9521
Mailing Address - Fax:817-297-3497
Practice Address - Street 1:740 S CROWLEY RD
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4354
Practice Address - Country:US
Practice Address - Phone:409-383-9521
Practice Address - Fax:817-297-3497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty